My child is not talking much. Does he have Autism?

One morning, a visibly distressed mother arrived with her 3-year-old son, who quietly followed her. Greeting them, I noticed the mother’s deep breath, a sign of her anxiety. “I’m worried,” she confessed. “Could my child have Autism Spectrum Disorder (ASD)?”

Background

As we delved deeper, the mother described her son’s behavior: he was restless, preferred solitary play, and spoke little. Calming her, we documented his case history: a family predisposition to ASD on the mother’s side, normal vision and hearing, and usual babbling phases between 10–12 months, with no significant medical history. His interests included playing with car toys, reminiscent of Thomas the Engine. The mother also disclosed his diagnosis of Global Developmental Delay (GDD). A relative at home, experienced in working with special needs children, had introduced Auslan sign language to the boy. The mother shared her observations: hand-flapping, toe-walking, and circling behaviors, raising concerns about ASD.’

Clinical Observations

While jotting down these details, I observed the boy playing with Hotwheels. I knelt down and engaged him using PROMPT strategies. He mimicked my actions and words, saying 'open', and offered a smile - a positive start. During the session, he moved frequently, seldom staying focused on an activity for more than 30 seconds, except when playing with cars and trucks.

In our interaction, he managed to articulate a few two-word phrases, such as 'I'm ok', 'My turn', and 'Help please', within an hour. However, his speech clarity was notably limited due to his restricted range of speech sounds. Additionally, he responded to his name, engaged in turn-taking during vocalization, indicated a need for help through hand-holding, and understood basic Auslan sign language. His connection with his mother was striking; she was highly positive and actively engaged with him, offering abundant praise.

The Problem

The boy is presented with limited language and speech sounds.
And, does the child have ASD?

Goal setting

Soon, me and mum have established some goals:
- For him to demonstrate age appropriate language
- For him to demonstrate age appropriate speech articulation skills
Mum also later mentioned that his child is on the waitlist for a developmental paediatrician review around ADHD and ASD.

Early Intervention: A Collaborative Process

The mother’s active participation in every session was vital. Our focus was on equipping her with strategies to facilitate her son’s language development at home, starting with simple, single-word interactions. For example, saying ‘more’ when he requested extended playtime. Often parents get so caught up with the idea of getting their chid to speak, they fall into the trap of excessive questioning and comments. This is not only is annoying, it also makes it hard for kids to associate words to meanings.

Our sessions evolved into a collaborative process: the family would arrive, the mother would update on progress, we would solve problems together, and I demonstrated techniques through play, followed by the mother’s participation and further suggestions from me.

As session progressed, our session went like this: family arrives, mum updates progress at home and engaged in problem solving with clinician, then clinician may demonstrate a technique with the child through play. This is followed by mum joining in and demonstrating that technique, clinician comments and make further suggestions.

Progress

After seven months of bi-weekly therapy, the boy’s progress was extraordinary. He began forming sentences of at least four words and used various sentence structures. His engagement improved significantly; he initiated interactions, maintained eye contact, and responded consistently. The mother and I were thrilled with his ongoing advancements.

I know I know, this perhaps sounds too much of a perfect story. Now, I share this not to brag about how talented or how knowledgable I am. I share this to show you the power of early intervention, and prove that every child is different.
Admittedly, not every one of my client has an inspiring story like him, there are clients where a whole year of therapy was to no avail.

Overall, I believe his progress comes down to this:
- Family support network
- Practice of therapy techniques at home
- Personal factors e.g., curious and outgoing personality, interests in words and stories
- Other factors: learning abilities, development process

Planning

Despite these achievements, his speech sound development remains a significant challenge. He demonstrates many age-inappropriate speech errors and is understood by only about 50–60% by unfamiliar listeners. We have increased our sessions to weekly to focus on his speech sounds, working on phonemes like ‘f’, ‘b’, and ‘p’. The boy struggles with understanding the positioning of his oral articulators and requires a variety of cues, including visual prompts, metaphoric cues, modeling, and tactile stimulation.

Additionally, there are some things to consider.
We anticipate challenges in phonological awareness, a key precursor to reading and writing skills. Research indicates that children with speech sound disorders often face difficulties in this area.

Final Words

Does he exhibit signs of ASD?
While a Speech Pathologist’s job does not involve diagnosing ASD, I would, if concerned, discuss red flags with mum. According to the DSM 5 Autism Diagnosis Criteria, there were no obvious signs of ASD. However, I did raise concerns around ADHD, also known as Attention-deficit/hyperactivity disorder displayed by the child’s difficulties in maintaining attention and this has been impacting his session particiaption.

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